A Review of the Risk Factors for Lower Extremity Overuse Injuries in Young Elite Female Ballet Dancers

Abstract

The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.

Bio-banding in Sport: Applications to Competition, Talent Identification, and Strength and Conditioning of Youth Athletes

“…The adolescent spurt is often indicated an interval during which youth are more susceptible to overuse and growth related injuries (20,21,30,42,66,73). The prevalence of apophyseal injuries, such as Osgood Schlatter's disease and Sever's disease among youth football players peaked during and just prior to the adolescent growth spurt, respectively, following a curve that was very similar to that of growth velocity in stature (73).…”

“…While empirical evidence remains somewhat limited, it has been argued that decrements in neuromuscular control during the growth spurt result in a decline in motor and functional performances (10), a need to relearn motor skills (21), and an increased potential risk of injury in (14,20,21,39,72,75). Similarly, it has been argued that an asynchrony between rates of growth in standing height and bone mass accumulation, occurring between stages 2 and 3 (Pubic Hair) of puberty, may predispose youth to a high incidence of fractures during this period (4,18,35,48).…”

“…Athletes entering phases of rapid development should also be educated on the potential risks to skill performance and their training programmes should be adjusted accordingly (21). Both education and implementation should be delivered by individuals (e.g., coaches, sports scientists, or medical staff) who have been trained in the assessment and interpretation of growth and maturity status, and who operate as part of a multi-disciplinary and integrated athlete support program.…”

National survey to evaluate musuloskeletal health in retired professional ballet dancers in the United Kingdom

“…These individuals frequently experience musculoskeletal injuries particularly those which are overuse in nature (Jacobs et al,2016;Bowerman, Whatman, Harris & Bradshaw, 2015). Professional dancers undergo specialisation in technique and performance from an early age, with full-time engagement in dancing most frequently starting aged 15 years and over (Ekegren, Quested, & Brodrick, 2014).…”

Single-leg squats can predict leg alignment in dancers performing ballet movements in “turnout”

“…In addition, ballet dancers perform with the legs “turned out” or with a combination of active hip and passive knee joint external rotation as well as passive foot pronation 9. The torsional loads encountered by the lower limb while dancing in turnout are suggested to increase the likelihood of a dancer moving with a valgus leg alignment 10,11. Protocols for assessing dancer leg alignment which incorporate turnout are now being established 12,13.…”